Changing roles

Thoracic surgery has changed profoundly in the 21st century. Multidisciplinary treatment is evolving and thoracic surgeons have become major team players in diseases related to thoracic oncology, infection, trauma, paediatric disorders and end-stage respiratory insufficiency.

The changing pattern of thoracic surgical practice is exemplified by a recent new classification of adenocarcinoma, which will have a profound impact on surgical decision making and treatment. For smaller tumours the role of sublobar resection is reconsidered as mentioned above. In the most recent revision of the Tumour, Nodes, Metastases (TNM) classification for lung cancer, important changes were made in the T and M descriptors, with definition of new subcategories. A new lymph node map was introduced together with the concept of nodal zones, reconciling previously published lymph node classifications. A prospective database has already been created to refine the classification ahead of the next revision.